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Ognjanovic S, Puumala S, Spector LG, Smith FO, Robison LL, Olshan AF, Ross JA. Maternal health conditions during pregnancy and acute leukemia in children with Down syndrome: A Children's Oncology Group study. Pediatr Blood Cancer 2009; 52:602-8. [PMID: 19148952 PMCID: PMC2659730 DOI: 10.1002/pbc.21914] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with Down syndrome (DS) have about a 20-fold increased risk of developing leukemia. Early childhood infections may protect against acute lymphoid leukemia (ALL) in children with and without DS. We examined whether maternal infections and health conditions during pregnancy were associated with acute leukemia in children with DS. PROCEDURE We conducted a case-control study of 158 children with DS and leukemia (including 97 cases with acute lymphoblastic leukemia (ALL) and 61 cases with acute myeloid leukemia (AML)) and 173 children with DS during the period 1997-2002. Maternal interview included information about 14 maternal conditions during gestation that are likely to induce an inflammatory response. We evaluated their prevalence in cases and controls. Five of these were common enough to allow analyses by leukemia subtype. RESULTS Vaginal bleeding was the most frequent (18% cases, 25% controls) and was associated with a reduced risk (odds ratio (OR) = 0.57; 95% confidence interval (CI) = 0.33-0.99) for all cases combined. Other variables, while showing a potential trend toward reduced risk had effect estimates, which were imprecise and not statistically significant. In contrast, amniocentesis was marginally associated with an increased risk of AML (OR = 2.06, 95% CI = 0.90-4.69). CONCLUSIONS Data from this exploratory investigation suggest that some health conditions during pregnancy may be relevant in childhood leukemogenesis. Larger epidemiological studies and other model systems (animal, clinical studies) may provide a clearer picture of the potential association and mechanisms.
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Affiliation(s)
- Simona Ognjanovic
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Susan Puumala
- Division of Pediatric Epidemiology & Clinical Research, University of Minnesota, Minneapolis, MN
| | - Logan G. Spector
- Division of Pediatric Epidemiology & Clinical Research, University of Minnesota, Minneapolis, MN,Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Franklin O. Smith
- Division of Hematology/Oncology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Andrew F. Olshan
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Julie A. Ross
- Division of Pediatric Epidemiology & Clinical Research, University of Minnesota, Minneapolis, MN,Masonic Cancer Center, University of Minnesota, Minneapolis, MN
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Ross JA, Blair CK, Olshan AF, Robison LL, Smith FO, Heerema NA, Roesler M. Periconceptional vitamin useand leukemia risk in children with Down syndrome: a Children's Oncology Group study. Cancer 2005; 104:405-10. [PMID: 15952191 DOI: 10.1002/cncr.21171] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Periconceptional vitamin supplementation reduces the risk of neural tube defects, and possibly may reduce the risk of certain childhood malignancies, including acute lymphoblastic leukemia (ALL). Because children with Down syndrome (DS) experience a 20-fold higher risk of leukemia than the general population, the authors evaluated whether periconceptional vitamin supplementation reduced the risk of leukemia in children with DS. METHODS From 1997 to 2002, 158 children ages birth-18 years with DS and acute leukemia (n = 61 children with acute myeloid leukemia [AML] and n = 97 children with ALL) were enrolled through the Children's Oncology Group in North America. Children with DS alone (n = 173) were identified through the cases' pediatric clinics and frequency matched to cases on age. Mothers of cases and controls completed a telephone interview that included questions regarding vitamin supplement use in the periconceptional period and after knowledge of pregnancy. RESULTS A decreased risk of leukemia was observed with vitamin supplementation in the periconceptional period (odds ratio [OR] = 0.63; 95% confidence interval [95% CI], 0.39-1.00). When stratified by leukemia type, the reduced risk was observed for ALL (OR = 0.51; 95% CI, 0.30-0.89), but not for AML (OR = 0.92; 95% CI, 0.48-1.76). Compared with vitamin use in the periconceptional period, use only after knowledge of pregnancy was associated with an increased risk of leukemia (OR = 1.61; 95% CI, 1.00-2.58). This was observed for both ALL and AML. CONCLUSIONS These data added to a growing body of evidence that suggests that periconceptional vitamin use may be protective in the development of certain childhood cancers.
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Affiliation(s)
- Julie A Ross
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Canfield KN, Spector LG, Robison LL, Lazovich D, Roesler M, Olshan AF, Smith FO, Heerema NA, Barnard DR, Blair CK, Ross JA. Childhood and maternal infections and risk of acute leukaemia in children with Down syndrome: a report from the Children's Oncology Group. Br J Cancer 2005; 91:1866-72. [PMID: 15520821 PMCID: PMC2409774 DOI: 10.1038/sj.bjc.6602223] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Children with Down syndrome (DS) are highly susceptible to acute leukaemia. Given the potential role of infections in the aetiology of leukaemia in children without DS, we investigated whether there was an association between early-life infections and acute leukaemia in children with DS. Maternal infections during pregnancy were also examined. We enrolled 158 incident cases of acute leukaemia in children with DS (97 acute lymphoblastic leukaemia (ALL) and 61 acute myeloid leukaemia (AML)) diagnosed at Children's Oncology Group institutions between 1997 and 2002. DS controls (N=173) were selected from the cases' primary care clinics and frequency matched on age at leukaemia diagnosis. Data were collected on demographics, child's medical history, mother's medical history, and other factors by maternal interview. Analyses were conducted using unconditional logistic regression adjusted for potential confounders. A significant negative association was observed between acute leukaemia and any infection in the first 2 years of life (adjusted odds ratio (OR)=0.55, 95% confidence interval (CI) (0.33–0.92); OR=0.53, 95% CI (0.29–0.97); and OR=0.59, 95% CI (0.28–1.25) for acute leukaemia combined, ALL, and AML respectively). The association between acute leukaemia and maternal infections during pregnancy was in the same direction but not significant. This study offers support for the hypothesis that early-life infections may play a protective role in the aetiology of acute leukaemia in children with DS.
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Affiliation(s)
- K N Canfield
- Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - L G Spector
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- University of Minnesota Cancer Center, USA
| | - L L Robison
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- University of Minnesota Cancer Center, USA
| | - D Lazovich
- Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA
- University of Minnesota Cancer Center, USA
| | - M Roesler
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- University of Minnesota Cancer Center, USA
| | - A F Olshan
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - F O Smith
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - N A Heerema
- Department of Pathology, The Ohio State University, Columbus, OH 43210, USA
| | | | - C K Blair
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- University of Minnesota Cancer Center, USA
| | - J A Ross
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- University of Minnesota Cancer Center, USA
- Department of Pediatrics, Division of Epidemiology and Clinical Research, University of Minnesota, MMC 422, 420 Delaware St SE, Minneapolis, MN 55455, USA. E-mail:
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Bogdanovic G, Jernberg ÅG, Priftakis P, Grillner L, Gustafsson B. Human herpes virus 6 or Epstein-Barr virus were not detected in Guthrie cards from children who later developed leukaemia. Br J Cancer 2004; 91:913-5. [PMID: 15292925 PMCID: PMC2409878 DOI: 10.1038/sj.bjc.6602099] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To investigate if children who later developed acute lymphoblastic leukaemia (ALL) were prenatally infected with HHV-6 and/or EBV, Guthrie cards taken at birth were analysed by PCR. Guthrie cards from 54 patients with ALL and 47 healthy controls matched for age and birth place were tested negative for both HHV-6 and EBV DNA. All samples contained amplifiable DNA when tested by HLA-DQ PCR. Our negative findings suggest that childhood ALL is unlikely to be associated with an in utero infection with EBV or HHV-6.
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Affiliation(s)
- G Bogdanovic
- Department of Clinical Microbiology, Karolinska University Hospital Solna, Karolinska Institutet, S-171 76 Stockholm, Sweden
| | - Å G Jernberg
- Department of Paediatrics, Karolinska University Hospital Huddinge, Karolinska Institutet, S-141 86 Stockholm, Sweden
| | - P Priftakis
- Department of Oncology-Pathology, Cancer Centre, Karolinska University Hospital Solna, Karolinska Institutet, S-171 76 Stockholm, Sweden
| | - L Grillner
- Department of Clinical Microbiology, Karolinska University Hospital Solna, Karolinska Institutet, S-171 76 Stockholm, Sweden
| | - B Gustafsson
- Department of Paediatrics, Karolinska University Hospital Huddinge, Karolinska Institutet, S-141 86 Stockholm, Sweden
- Department of Paediatrics, Karolinska University Hospital Huddinge, Karolinska Institutet, S-141 86 Stockholm, Sweden. E-mail:
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Isa A, Priftakis P, Broliden K, Gustafsson B. Human parvovirus B19 DNA is not detected in Guthrie cards from children who have developed acute lymphoblastic leukemia. Pediatr Blood Cancer 2004; 42:357-60. [PMID: 14966833 DOI: 10.1002/pbc.20001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There has been much speculation about the cause of childhood acute lymphoblastic leukemia (ALL). It has been suggested, on the basis of findings in epidemiological studies, that ALL may be initiated by an in utero infection of the fetus. The human parvovirus B19 (B19) is etiologically related to human diseases, including erythema infectiosum and aplastic crisis, but it has not yet been considered to be involved in the development of ALL. Therefore, the aim of this study was to investigate, whether prenatal B19 infection could still be indirectly correlated with the development of childhood ALL. PROCEDURES Fifty-four Guthrie cards, collected at 3-5 days of age, from Swedish children who subsequently developed ALL, as well as from 50 healthy controls, were investigated by nested PCR for the presence of B19 DNA. RESULTS B19 DNA was not detected in any of the Guthrie cards from ALL patients or from healthy controls, although all tested samples had amplifiable cellular DNA as confirmed by an HLA DQ specific PCR. CONCLUSION B19 DNA was not found in any of the Guthrie cards from children who later developed ALL or in the healthy controls. These findings suggest that it is less likely that childhood ALL is associated with an in utero in fection with B19.
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Affiliation(s)
- Adiba Isa
- Department of Immunology, Microbiology, and Pathology, Division of Clinical Virology, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden
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Priftakis P, Dalianis T, Carstensen J, Samuelsson U, Lewensohn-Fuchs I, Bogdanovic G, Winiarski J, Gustafsson B. Human polyomavirus DNA is not detected in Guthrie cards (dried blood spots) from children who developed acute lymphoblastic leukemia. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 40:219-23. [PMID: 12555248 DOI: 10.1002/mpo.10246] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Epidemiological evidence has suggested that some childhood acute lymphoblastic leukemia (ALL) may be initiated in utero and may have an infectious etiology. The human polyomavirus JC virus (JCV) has been discussed as a candidate virus, but its presence has not been demonstrated in leukemia cells from children with ALL. The aim of this study was, therefore, to investigate if prenatal human polyomavirus infection could still indirectly be correlated to the development of childhood ALL. PROCEDURE Fifty-four Guthrie cards (stored, dried blood spots filter papers, routinely collected from newborns for different screening analyses), collected at 3-5 days of age, from Swedish children who subsequently developed ALL, as well as from 37 healthy controls, were investigated by nested PCR for the presence of human polyomaviruses JCV and BK virus (BKV). RESULTS JCV and BKV DNA were not detected in any of the Guthrie cards from ALL patients or from healthy controls, although all tested samples had amplifiable DNA as confirmed by an HLA DQ PCR. CONCLUSIONS JCV or BKV were not found in any of the dried blood spots of children who later developed ALL or in the healthy controls. These findings suggest that it is unlikely that childhood ALL is associated with an in utero infection with JCV or BKV, although it is not possible to exclude an association with an in utero infection that has become latent in the kidneys with very low levels of circulating virus at birth.
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Affiliation(s)
- Peter Priftakis
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
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Alvarez S, MacGrogan D, Calasanz MJ, Nimer SD, Jhanwar SC. Frequent gain of chromosome 19 in megakaryoblastic leukemias detected by comparative genomic hybridization. Genes Chromosomes Cancer 2001; 32:285-93. [PMID: 11579469 DOI: 10.1002/gcc.1192] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Acute megakaryocytic leukemia is a rare subtype of AML that is often difficult to diagnose; it is most commonly associated with Down syndrome in children. To identify chromosomal imbalances and rearrangements associated with acute megakaryocytic leukemia, we used G-banding, comparative genomic hybridization (CGH), and whole chromosome painting (WCP) on a variety of primary patients' samples and leukemia cell lines. The most common abnormality was gain of chromosome 19 or arm 19q, which was detected by CGH in four of 12 (33.3%) primary samples and nine of 11 (81.8%) cell lines. In none of the primary samples was this abnormality detected by G-banding analysis. WCP was used to define further the nature of the chromosome 19 gain in the cell lines, which was found to be due to the presence of additional 19q material on marker chromosomes or to cryptic translocations involving 19q. The most common chromosomal loss--detected only in the cell lines--was deletion of chromosomal band 13q14, which was seen in six of 11 (54.5%) cell lines. Other recurrent changes included gains of 1p, 6p, 8q, 11q, 15q, 17q, and 21q and losses of 2, 4q, 5q, 7q, 9p, and 11p. Combining conventional and molecular cytogenetic analyses defined recurrent clonal chromosomal abnormalities, which will aid in the identification of critical genes that are abnormal in acute megakaryocytic leukemia cells.
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Affiliation(s)
- S Alvarez
- Laboratory of Molecular Aspects of Hematopoiesis, Sloan-Kettering Institute for Cancer Research, New York, New York 10021, USA
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Abstract
With the exception of a small percentage of cases attributable to hereditary cancer syndromes (eg, familial retinoblastoma) or genetic syndromes (Down syndrome), the etiology of most childhood cancers is unknown. Recent epidemiologic studies have focused on the prenatal period and have investigated potential associations with parental age, cigarette smoking, birth weight of the child, parental occupational exposures, and specific environmental exposures. The following challenges lie ahead for future epidemiologic studies of childhood cancer: 1) improvement of diagnostic classification; 2) improved methods for exposure assessment; 3) evaluation of data from molecular biology to generate biologically derived hypotheses; and 4) incorporation of markers of genetic susceptibility when feasible.
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Affiliation(s)
- J A Ross
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota Medical School, Box 422, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
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